Most adolescent smokers want to quit and have tried to unsuccessfully. While adult cessation counseling is effective, the evidence for cessation counseling for adolescents is limited. We propose a pilot study essential to developing future randomized clinical trials of the effectiveness of adolescent cessation interventions in pediatric primary care settings. In a previous AHRQ funded study, we piloted clinician training and practice systems change interventions. In this proposed R-21 project, we build on these successful strategies and pilot delivery of interventions to adolescents, evaluation of adolescent receipt of counseling, and cessation outcomes. We will test these strategies in partnership with the American Academy of Pediatrics Pediatric Research in Office Settings (PROS) practice based research network (PBRN). Our specific aims are to: 1) Establish the feasibility of practices' recruitment of adolescents and families for research evaluation; 2) Further demonstrate fidelity to implementation and maintenance of guidelines based system changes and clinician cessation counseling interventions over time, including: a) systematic screening using charting tools; b) behavior change counseling using the public health service 5 A's model, and c) clinician referral of adolescent patient to Internet and community-based adjuncts and resources, and 3) Assess the impact of these pilot interventions on delivery of cessation interventions, and on intermediate outcomes, including self-reported quit attempts and cessation outcomes. We will evaluate practice recruitment and smoking cessation training and delivery by providers in 10 PROS practice sites, and assess acceptability of study procedures to adolescents in these sites. Our systems intervention draws from literature on practice systems changes using Wagner's chronic disease Care Model, and our clinical interventions on the transtheoretical (stages of change) model and the Public Health Service 5A model for effective behavior change counseling. Up to 1000 adolescents will complete a short baseline survey prior to well-visits. Smokers will be surveyed by phone at 2-3 weeks and at 3 and 6 months, to provide preliminary estimates of cessation outcomes for future studies. We will test measures, describe patterns of smoking among youth, and explore the effect of interventions on motivation, quitting, abstinence/ relapse attitudes, and other smoking behaviors for 100 smokers. This project will result in pilot data on implementation essential to conducting future large PBRN-based trials of adolescent cessation in pediatric care. Studying clinician interventions in primary care community-based pediatric practice has the potential to lead to improved clinical preventive services for tobacco cessation and also to rapid dissemination of effective interventions. [unreadable] [unreadable] [unreadable]